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Prepared for:Created: 06/05/2021Attached is a directory of network medical providers for your use in obtaining workers' compensation medical care for your employees. The providers listed inthis directory are independent contractors and are not the agents or employees of Gallagher Bassett. The attached directory information is intended to assist indirecting the medical care of employees with workers compensation claims where allowed by applicable law. The information contained herein is subject tochange without notice. Gallagher Bassett does not warrant the accuracy of the information or the quality of the medical care.

Gallagher Bassett Providers for: Gallagher Bassett Platinum 1457, 2349, 2346, 2350, 2470, 2471 CA MPN Roster of Treating PhysiciansTable of Contents by County/CityAlameda / Alameda, CAAlameda / Anaheim, CAAlameda / Berkeley, CAAlameda / Castro Valley, CAAlameda / Dublin, CAAlameda / Emeryville, CAAlameda / Fremont, CAAlameda / Hayward, CAAlameda / Livermore, CAAlameda / Oakland, CAAlameda / Pleasanton, CAAlameda / San Francisco, CAAlameda / San Leandro, CAAlameda / San Ramon, CAAlameda / Union City, CAButte / Chico, CAButte / Newport Beach, CAButte / Oroville, CAContra Costa / Antioch, CAContra Costa / Brentwood, CAContra Costa / Concord, CAContra Costa / Lafayette, CAContra Costa / Martinez, CAContra Costa / Orinda, CAContra Costa / Pinole, CAContra Costa / Richmond, CAContra Costa / San Ramon, CAContra Costa / Walnut Creek, CADel Norte / Crescent City, CAEl Dorado / El Dorado Hills, CAFresno / Clovis, CAFresno / Fresno, CAFresno / Reedley, CAHumboldt / Eureka, CAImperial / Brawley, CAImperial / El Centro, CAInyo / Bishop, CAKern / Bakersfield, CAKern / Ridgecrest, CAKern / Tehachapi, CAKings / Hanford, CALake / Lakeport, CALassen / Bieber, CALassen / Susanville, CALos Angeles / Alhambra, CALos Angeles / Arcadia, CALos Angeles / Azusa, CALos Angeles / Baldwin Park, CALos Angeles / Beverly Hills, CALos Angeles / Burbank, 171717191919192020222223232323232324242424Los Angeles / Carson, CALos Angeles / Chatsworth, CALos Angeles / City of Industry, CALos Angeles / Claremont, CALos Angeles / Commerce, CALos Angeles / Compton, CALos Angeles / Covina, CALos Angeles / Downey, CALos Angeles / Duarte, CALos Angeles / El Monte, CALos Angeles / El Segundo, CALos Angeles / Encino, CALos Angeles / Gardena, CALos Angeles / Glendale, CALos Angeles / Glendora, CALos Angeles / Hawaiian Gardens, CALos Angeles / Hawthorne, CALos Angeles / Huntington Park, CALos Angeles / Industry, CALos Angeles / Irwindale, CALos Angeles / La Mirada, CALos Angeles / La Verne, CALos Angeles / Lakewood, CALos Angeles / Lancaster, CALos Angeles / Lawndale, CALos Angeles / Long Beach, CALos Angeles / Los Angeles, CALos Angeles / Malibu, CALos Angeles / Manhattan Beach, CALos Angeles / Marina del Rey, CALos Angeles / Mission Hills, CALos Angeles / Montebello, CALos Angeles / Monterey Park, CALos Angeles / Newhall, CALos Angeles / North Hollywood, CALos Angeles / Northridge, CALos Angeles / Norwalk, CALos Angeles / Pacific Palisades, CALos Angeles / Palmdale, CALos Angeles / Paramount, CALos Angeles / Pasadena, CALos Angeles / Pico Rivera, CALos Angeles / Pomona, CALos Angeles / Porter Ranch, CALos Angeles / San Dimas, CALos Angeles / Santa Clarita, CALos Angeles / Santa Fe Springs, CALos Angeles / Santa Monica, CALos Angeles / Saugus, CALos Angeles / Sherman Oaks, 54Los Angeles / Stevenson Ranch, CALos Angeles / Sun Valley, CALos Angeles / Sylmar, CALos Angeles / Tarzana, CALos Angeles / Torrance, CALos Angeles / Valencia, CALos Angeles / Van Nuys, CALos Angeles / Vernon, CALos Angeles / Walnut, CALos Angeles / West Covina, CALos Angeles / West Hills, CALos Angeles / West Hollywood, CALos Angeles / Whittier, CALos Angeles / Woodland Hills, CAMadera / Madera, CAMarin / Corte Madera, CAMarin / Green Brae, CAMarin / Mill Valley, CAMarin / Novato, CAMarin / San Rafael, CAMendocino / Boonville, CAMerced / Atwater, CAMerced / Los Banos, CAMerced / Merced, CAMonterey / Castroville, CAMonterey / Greenfield, CAMonterey / King City, CAMonterey / Monterey, CAMonterey / Prunedale, CAMonterey / Salinas, CAMonterey / Soledad, CAMonterey / Watsonville, CANapa / American Canyon, CANapa / Napa, CANevada / Grass Valley, CANevada / Truckee, CAOrange / Aliso Viejo, CAOrange / Anaheim, CAOrange / Brea, CAOrange / Costa Mesa, CAOrange / Foothill Ranch, CAOrange / Fountain Valley, CAOrange / Fullerton, CAOrange / Garden Grove, CAOrange / Huntington Beach, CAOrange / Irvine, CAOrange / La Palma, CAOrange / Laguna Beach, CAOrange / Laguna Hills, CAOrange / Lake Forest, CAProvider information is subject to change. When making appointments, please confirm the provider's information. Use of a networkprovider does not confirm or verify compensability under the Workers' Compensation Act. Telehealth 73747475TOC 1

Gallagher Bassett Providers for: Gallagher Bassett Platinum 1457, 2349, 2346, 2350, 2470, 2471 CA MPN Roster of Treating PhysiciansTable of Contents by County/CityOrange / Los Alamitos, CAOrange / Mission Viejo, CAOrange / Newport Beach, CAOrange / Orange, CAOrange / Placentia, CAOrange / San Clemente, CAOrange / Santa Ana, CAOrange / Seal Beach, CAOrange / Stanton, CAOrange / Tustin, CAOrange / Westminster, CAPlacer / Auburn, CAPlacer / Olympic Valley, CAPlacer / Rocklin, CAPlacer / Roseville, CARiverside / Banning, CARiverside / Beaumont, CARiverside / Blythe, CARiverside / Coachella, CARiverside / Corona, CARiverside / Hemet, CARiverside / Indio, CARiverside / Lake Elsinore, CARiverside / March Air Reserve Base, CARiverside / Moreno Valley, CARiverside / Murrieta, CARiverside / Palm Desert, CARiverside / Palm Springs, CARiverside / Perris, CARiverside / Rancho Mirage, CARiverside / Riverside, CARiverside / Temecula, CARiverside / Wildomar, CASacramento / Carmichael, CASacramento / Citrus Heights, CASacramento / El Dorado Hills, CASacramento / Elk Grove, CASacramento / Folsom, CASacramento / Orangevale, CASacramento / Rancho Cordova, CASacramento / Rio Linda, CASacramento / Sacramento, CASan Benito / Hollister, CASan Bernardino / Adelanto, CASan Bernardino / Apple Valley, CASan Bernardino / Chino, CASan Bernardino / Chino Hills, CASan Bernardino / Colton, CASan Bernardino / Fontana, CASan Bernardino / Hesperia, 9696979799100San Bernardino / Lake Arrowhead, CASan Bernardino / Ontario, CASan Bernardino / Rancho Cucamonga, CASan Bernardino / Redlands, CASan Bernardino / Rialto, CASan Bernardino / San Bernardino, CASan Bernardino / Upland, CASan Bernardino / Victorville, CASan Diego / Carlsbad, CASan Diego / Chula Vista, CASan Diego / Coronado, CASan Diego / Encinitas, CASan Diego / Escondido, CASan Diego / Fallbrook, CASan Diego / La Jolla, CASan Diego / La Mesa, CASan Diego / Mission Valley, CASan Diego / National City, CASan Diego / Oceanside, CASan Diego / Poway, CASan Diego / San Diego, CASan Diego / San Marcos, CASan Diego / Santee, CASan Diego / Vista, CASan Francisco / San Francisco, CASan Joaquin / Lodi, CASan Joaquin / Manteca, CASan Joaquin / Stockton, CASan Joaquin / Tracy, CASan Luis Obispo / Arroyo Grande, CASan Luis Obispo / Los Osos, CASan Luis Obispo / Pismo Beach, CASan Luis Obispo / San Luis Obispo, CASan Luis Obispo / Templeton, CASan Mateo / Burlingame, CASan Mateo / Daly City, CASan Mateo / Menlo Park, CASan Mateo / Redwood City, CASan Mateo / San Carlos, CASan Mateo / South San Francisco, CASanta Barbara / Lompoc, CASanta Barbara / Santa Barbara, CASanta Barbara / Santa Maria, CASanta Barbara / Solvang, CASanta Clara / Campbell, CASanta Clara / Gilroy, CASanta Clara / Los Altos, CASanta Clara / Los Gatos, CASanta Clara / Milpitas, CASanta Clara / Morgan Hill, 42Santa Clara / Mountain View, CASanta Clara / San Jose, CASanta Clara / Santa Clara, CASanta Clara / Sunnyvale, CASanta Cruz / Freedom, CASanta Cruz / Soquel, CASanta Cruz / Watsonville, CAShasta / Anderson, CAShasta / Redding, CASiskiyou / Dorris, CASiskiyou / Yreka, CASolano / Benicia, CASolano / Fairfield, CASolano / Vacaville, CASolano / Vallejo, CASonoma / Petaluma, CASonoma / Rohnert Park, CASonoma / Santa Rosa, CASonoma / Sonoma, CAStanislaus / Modesto, CAStanislaus / Newman, CAStanislaus / Turlock, CATehama / Red Bluff, CATulare / Porterville, CATulare / Strathmore, CATulare / Tulare, CATulare / Visalia, CATuolumne / Sonora, CAVentura / Camarillo, CAVentura / Oxnard, CAVentura / Santa Paula, CAVentura / Simi Valley, CAVentura / Thousand Oaks, CAVentura / Ventura, CAVentura / Westlake Village, CAYolo / Davis, CAYolo / West Sacramento, CAYolo / Woodland, CAYuba / Marysville, CAProvider information is subject to change. When making appointments, please confirm the provider's information. Use of a networkprovider does not confirm or verify compensability under the Workers' Compensation Act. Telehealth 4154154155155156156156157TOC 2

Gallagher Bassett Providers for: Gallagher Bassett Platinum 1457, 2349, 2346, 2350, 2470, 2471 CA MPN Roster of Treating PhysiciansProviders grouped by county, city and specialty, listed in name order.Alameda, CANeurologyAlamedaSurgery: OrthopedicNolan, Richard A., MDRichard A Nolan MD2100 Otis Dr Ste BAlameda, CA 94501510-523-4040AnaheimSurgery: OrthopedicNorthfield, Mark R., MDSt Jude Hospital Yorba LindaInc200 W. Center Street Suite400Anaheim, CA 92805714-449-4800BerkeleyChiropractorBelfer, Howard, MDConcentra Medical Center2850 Seventh Street Suite 100Berkeley, CA 94710510-845-5170Kang, Gail A., MDSegars, Hoke C., MD3000 Colby St Ste 101Berkeley, CA 94705510-644-2282Kang, Gail A., MDSegars, Hoke C., MD2999 Regent St Ste 627Berkeley, CA 94705510-644-2282Occupational MedicineBlackshear, Charles P.Concentra Medical Center2850 Seventh Street Suite 100Berkeley, CA 94710510-845-5170PhysiatryReyes, Regalado Pagtakhan, DCConcentra Medical Centers2850 7th St Ste 100Berkeley, CA 94710510-845-5170Cheng, Ernest Y., DOConcentra Medical Center2850 Seventh Street Suite 100Berkeley, CA 94710510-845-5170Sports MedicineBusfield, Benjamin Thomas, MDConcentra Medical Centers06/05/2021(cont)2850 7th St Ste 100Berkeley, CA 94710510-845-5170Sports MedicineSurgery: OrthopedicBusfield, Benjamin T., MDConcentra Medical Center2850 Seventh Street Suite 100Berkeley, CA 94710510-845-5170Busfield, Benjamin Thomas, MDConcentra Medical Centers2850 7th St Ste 100Berkeley, CA 94710510-845-5170Eppley, Robert A., MDCalifornia Orthopedic &Sports InstituteCalifornia Sports &Orthopedic InstituteSegars, Hoke C., MD2999 Regent St Ste 225Berkeley, CA 94705510-704-7760Zwahlen, Brad A., MDCalifornia Sports &Orthopedic InstituteSegars, Hoke C., MD2999 Regent St Ste 225Berkeley, CA 94705510-704-7760Surgery: Plastic (Hand)Hsieh, Jing W., MDConcentra Medical Center2850 Seventh Street Suite 100Berkeley, CA 94710510-845-5170Provider information is subject to change. When making appointments, please confirmthe provider's information. Use of a network provider does not confirm or verifycompensability under the Workers' Compensation Act. Telehealth providerCastro ValleyDemorest, Rebecca A., MD, DOWebster Orthopedics19842 Lake Chabot RdCastro Valley, CA 94546925-556-7320Surgery: OrthopedicStuffmann, Eric S., MDWebster Orthopedics19842 Lake Chabot RdCastro Valley, CA 94546925-556-7350Surgery: Orthopedic (Hand)Stuffmann, Eric S., MDWebster Orthopedics19842 Lake Chabot RdCastro Valley, CA 94546925-556-7350DublinInternal MedicineWilkie Jr., Harold Washington,MDSutter East Bay MedicalFoundation7667 Amador Valley Blvd Suite100Page 1: Alameda / Alamedato Alameda / Dublin

Gallagher Bassett Providers for: Gallagher Bassett Platinum 1457, 2349, 2346, 2350, 2470, 2471 CA MPN Roster of Treating PhysiciansProviders grouped by county, city and specialty, listed in name order.(cont)Dublin, CA 94556925-828-9211(cont)6001 Shellmound St Ste 115Emeryville, CA 94608510-653-5200Sports MedicineFremontCardiologyDemorest, Rebecca A., MD, DOWebster Orthopaedic MedicalGroup Inc4000 Dublin Blvd Ste 100Dublin, CA 94568925-556-7320Surgery: OrthopedicStuffmann, Eric S., MDWebster Orthopaedic MedicalGroup IncWebster Orthopedics4000 Dublin Blvd Ste 100Dublin, CA 94568800-943-8099, 925-556-7320Surgery: Orthopedic(Hand)Balakrishnan, Sangeetha L.,MDWashington Township MedicalFoundation2287 Mowry Ave Suite H-IFremont, CA 94538510-248-1680EmeryvilleOccupational MedicineVan Tassel, Jason R., MDWashington Township MedicalFoundation2557 Mowry Ave Ste 30Fremont, CA 94538510-248-1590Curran, Steven, MDWashington HospitalWashington Township MedicalFoundation46690 Mohave DrFremont, CA 94539510-248-1065Internal MedicineNarra, Kishore B., MDKishore B NarraWashington Hospital716 Mowry AveFremont, CA 94536510-792-1390Washington Township MedicalFoundation39141 Civic Center Dr Ste 335Fremont, CA 94538510-248-1000OphthalmologyLee, Scott S., MDEast Bay Retina Consultants,Inc- Freemont OfficeEast Bay Retina Consultants,IncUrgently Ortho Medical Group1860 Mowry Ave Suite 308Fremont, CA 94538510-444-1600, 510-796-6500Pain ManagementPhysical Medicine/RehabilitationLee, Donald T., DOBizmed Occupational HealthClinic42650 Christy StFremont, CA 94538510-226-8832Narra, Kishore B., MDKishore B NarraWashington Hospital716 Mowry AveFremont, CA 94536510-792-1390Provider information is subject to change. When making appointments, please confirmthe provider's information. Use of a network provider does not confirm or verifycompensability under the Workers' Compensation Act. Telehealth providerGanga, Anupama, MDIntegrated Pain ManagementMedical Group Inc38069 Martha Ave Ste 300Fremont, CA 94536510-744-9153Occupational MedicineNyquist, Julia R.Concentra Medical Center3161 Walnut AvenueFremont, CA 94538Gest, Steven A., MDEmeryville OccupationalMedical Center I06/05/2021Martin, Dianne C., MDWashington Township MedicalFoundation2191 Mowry Ave Ste 500CFremont, CA 94538510-248-1585(cont)510-769-1000Ear, Nose & Throat (Otolaryngology) Shariat, Cyrus, MDFamily PracticeStuffmann, Eric S., MDWebster Orthopaedic MedicalGroup IncWebster Orthopedics4000 Dublin Blvd Ste 100Dublin, CA 94568800-943-8099, 925-556-7320Giddens, John Jr., MDConcentra Medical Centers3161 Walnut AveFremont, CA 94538510-796-1000Ganga, Anupama, MDIntegrated Pain ManagementMedical Group Inc38069 Martha Ave Ste 300Fremont, CA 94536510-744-9153Goldin, Michael, MDWashington Township MedicalFoundation38690 Stivers St Suite AFremont, CA 94536510-248-1040, 510-248-1044Goldin, Michael, MDWashington Township MedicalFoundationPage 2: Alameda / Dublin to Alameda / Fremont

Gallagher Bassett Providers for: Gallagher Bassett Platinum 1457, 2349, 2346, 2350, 2470, 2471 CA MPN Roster of Treating PhysiciansProviders grouped by county, city and specialty, listed in name order.(cont)2500 Mowry Ave Suite 222Fremont, CA 94538510-818-1160Narra, Kishore B., MDKishore B NarraWashington Hospital716 Mowry AveFremont, CA 94536510-792-1390(cont)39180 Farwell Dr Ste 211Fremont, CA 94538510-857-1000Koransky, Mark L., MDWashington Township MedicalFoundation2000 Mowry AveFremont, CA 94538510-248-1000Sports MedicineSurgery: OrthopedicKale, Ashay A., MDMission Peak OrthopaedicMedical Group In39350 Civic Center Dr Ste 300Fremont, CA 94538510-797-3933Nord, Russell, MDWashington Township MedicalFoundation38690 Stivers St Suite AFremont, CA 94536510-248-1040Pang, Donald, MD38162 Glenmoor DrFremont, CA 94536510-793-8754Ting, Arthur J., MDArthur J TingArthur Ting39470 Paseo Padre PkwyFremont, CA 94538510-797-5550Surgery: GeneralBesh, Basil, MDAccess OmnicareForm Hand Wrist & ElbowInstitute06/05/2021Besh, Basil, MDAccess OmnicareForm Hand Wrist & ElbowInstitute39180 Farwell Dr Ste 211Fremont, CA 94538510-857-1000Dearborn, John T., MDCenter for Joint Replacement2000 Mowry AveFremont, CA 94538510-818-7200Harrell, Jill Lindsay, MDWashington Township MedicalFoundation2000 Mowry AveFremont, CA 94538510-797-1111Harrell, Jill Lindsay, MDWashington Township MedicalFoundation38690 Stivers St Suite AFremont, CA 94538510-248-1044Henstorf, Jan Eric, MDWashington Township MedicalFoundation38690 Stivers St Ste AFremont, CA 94536(cont)510-248-1040Kale, Ashay A., MDConcentra Medical Center3161 Walnut Ave.Fremont, CA 94538510-796-1000Kale, Ashay A., MDMission Peak OrthopaedicMedical Group In39350 Civic Center Dr Ste 300Fremont, CA 94538510-797-3933Molina, Ricardo A., MDMission Peak OrthopaedicMedical Group In39350 Civic Center Dr Ste 300Fremont, CA 94538510-797-3933Motamed, Soheil, MDMission Peak OrthopaedicMedical Group In39350 Civic Center Dr Ste 300Fremont, CA 94538510-797-3933Nord, Russell, MDWashington Township MedicalFoundation38690 Stivers St Suite AFremont, CA 94536510-248-1040Pang, Donald, MD38162 Glenmoor DrFremont, CA 94536510-793-8754Stearns, William R., MDWashington Township MedicalFoundation38690 Stivers St Suite AFremont, CA 94536510-248-1040, 510-248-1044Surgery: Orthopedic (Hand)Besh, Basil, MDAccess OmnicareForm Hand Wrist & ElbowInstitute39180 Farwell Dr Ste 211Fremont, CA 94538510-857-1000Kilaru, Prasad G., MDConcentra Medical Center3161 Walnut Ave.Fremont, CA 94538510-796-1000Pang, Donald, MD38162 Glenmoor DrFremont, CA 94536510-793-8754HaywardSports MedicineKale, Ashay A., MDMission Peak OrthopaedicMedical Group In27206 Calaroga Ave Ste 107Hayward, CA 94545510-300-9898Surgery: OrthopedicTing, Arthur J., MDArthur J TingArthur TingProvider information is subject to change. When making appointments, pleaseconfirm the provider's information. Use of a network provider does not confirm orverify compensability under the Workers' Compensation Act. Telehealth provider(cont)39470 Paseo Padre PkwyFremont, CA 94538510-797-5550Kale, Ashay A., MDMission Peak OrthopaedicMedical Group InPage 3: Alameda / Fremontto Alameda / Hayward

Gallagher Bassett Providers for: Gallagher Bassett Platinum 1457, 2349, 2346, 2350, 2470, 2471 CA MPN Roster of Treating PhysiciansProviders grouped by county, city and specialty, listed in name order.(cont)27206 Calaroga Ave Ste 107Hayward, CA 94545510-300-9898(cont)1364 Concannon BlvdLivermore, CA 94550925-691-9806Molina, Ricardo A., MDMission Peak OrthopaedicMedical Group In27206 Calaroga Ave Ste 107Hayward, CA 94545510-797-3933Physical Medicine/RehabilitationMotamed, Soheil, MDMission Peak OrthopaedicMedical Group In27206 Calaroga Ave Ste 107Hayward, CA 94545510-300-9898LivermoreChiropractorDave, Neesha Anil, DOIntegrated Pain ManagementMedical Group Inc1364 Concannon Blvd BuildingHLivermore, CA 94550925-691-9806OaklandAllergy & ImmunologyGeneral PracticeSamaniego, Armando G., MDSutter East Bay MedicalFoundation4465 1st StLivermore, CA 94551925-315-8828Lenoir, Michael A., MDChildrens First HealthcareNetworkComprehensive AllergyServicesLifelong Medical CareSegars, Hoke C., MD2940 Summit St Ste 1bOakland, CA 94609510-834-4897Pain ManagementDave, Neesha Anil, DOIntegrated Pain ManagementMedical Group Inc1364 Concannon Blvd BuildingHLivermore, CA 94550925-691-9806Rosenberg, Jacob A., MDIntegrated Pain ManagementMedical Group Inc06/05/2021Kim, Jin Kwan, MDJin Kwan Kim MDSegars, Hoke C., MD3300 Webster St Ste 1105Oakland, CA 94609510-208-5400Lenoir, Michael A., MDComprehensive AllergyservicesLifelong Medical CareWu Lee Quock MedicalCorporation80 Grand Ave Suite 500Oakland, CA 94612510-993-0200CardiologyAzizi, Khaled A., DCConcentra Medical Centers384 Embarcadero WOakland, CA 94607510-465-9565Conlon, Britta, DCConcentra Medical Centers384 Embarcadero WOakland, CA 94607510-465-9565Jung, Seunghun, DCConcentra Medical